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PUS, BUMS, STICKS, What I didn't include= Drains, Human bites (c and…
PUS, BUMS, STICKS
Cat Fight Abscess
Problematic
hard to close
Sig. morbidity
Pathogens involved
Path
Injection of
organism (
bite/scratch)
Neutrophil + phagocyte
infiltration= PUS
Body
Walls off
infection= Fluctulant mass
if
P necrosis
of dermis= BURSTS
CS
Pyrexic
"not himself,", lame, painful, GRUMPY
Overt mass
Cellulitis
(swollen, no frank pus)
Regiona
l lymphadenopathy
Discharge, necrotic skin
Tx
NEW/ cellulitis=
Abx, pain relief
Amoxy-clav, metronidazole (nausea
), Doxycycline, Clindamycin
Which ABx?
Oral, mixed flora
Obligate Anaerobes=
Porphyromonas (VERY COMMON)
Fusobacterium, Bacteroides, Beta-haemolytic Strep
Facultative anaerobes= Pasturella multocid
a (MOST COMMON), Corynebacterium, Actinomyces
ONE WEEK
(uncomplicated)
Sx
NOT if has cellulitis (no pus to drain)
OPTION 1
Sedate,
lance, drain, flush
+ve=
inexpensive
-ve= often close over,
need repeat drainage, mess
y
OPTION 2
GA,
Drain, debride, flush,
close dead space
(don't close SC layer),
place drain
Flushes= saline. dilute betadine (NOT hydrogen peroxide)
POST OP
Abx 1 wk, pain- meloxicam, Remova edrain (not functioning/ 2-3d), Sutures 7-10d
THE COMPLICATED ABSCESS
1. Recurs
after Abx/
doesn't respond
to Abx/
NON HEALING
Test for
FIV and FeLV
FB:
explore/ US
Histopath and culture
Inguinal fat pad involved=
NHW
Tx
: mnths of Abx based on C & S, repeated debriding
Cause= Nocardia, Mycobacterium, Fungi
do PCR for Mycobacterium on pus
Involves a
joint
Dx: rads, C & S
Tx: Flush joint, Abx 4-6 wks
3. Discharging
Sinuses/
Necrotic Fat
Anal Dz
Atresia An
i
congenital, rare
POOR PROG- euth.
Perianal Fistula
"Anal Furunculosis"
= chronic draining tract in perianal region
Sx: low tail carriage (GSD)
Path: unknown (genetics/ imm)
Concurrent colitis/ constipation
Tx: MEDICAL
Abx
: Cephalexin/ metronidazole
Imm drugs
(Cyclosporin +/- ketoconazole, topical tacrolimus 0.1%)
Stool softener
s
UP TO 1 YR
SAC Dz
= failure to empty= inflammation, infection. WHY=
Normal bulky faeces= effective emptying
Aberrant anatomy
- small duct/ aberrant duct placement
Abnormal
anal tone
Derm dz
= plugs duct/ infection
Infection=
E.coli, Strep, Clostridium
Full sac= impacted= ascending infection= anal sacculitis=
abscess
CS
Scooting, pruritis, pain
Dyschezia, tenesmus
Fever
DIscharging sinus
Large sac on palpation
Contents of sac dry/ purulent/ haemorrhagic
Scooting Ddx
= Perineal pruritis, tapeworm
Tx
IMPACTION:
empty sac, repeat in a few mnths/wks
SACCULITIS
: GA, insert 23G catheter into duct, flush til clear, Abx/steroid cream into sac until full.
ABSCESS
: flush as for sacculitis, leave open (2ndary intention), Hax 10-14d (Cephalexin, Clinamycin, Amoxy-clav)
Masses:
see prev lect.
FB
GRASS SEEDS
Sites: Ears, nose, eye, ventrum, ventral mandible
Check Long haired d/ clip them
Tx
Remove FB
Look for tract- probe
Debride necrotic tissue, flush with saline
CLosure as for abscess
Abx: soil microbes (Amoxyclav
MIGRATING?
CS=
vague malaise, "not himself,", pyrexia, back pain, reduced apetitie, weight loss, abdo pain, cough
Sx: active d
Tx: partial response to Abx
CHRONIC CS
(not just during the season)
CHECK OROPHARYNX (through thorax, diaphragm to sub-lumbar region)
Pharyngeal Stick Injuries
SCENARIO 1
CS: dysphagia, cellulitis, abscessation
Tx: as for FB, explore under GA
POOR PROG- oesophageal injury
SCENARIO 2
discharging sinus, wks- 1yr after injury
FB not always present- can cause abscess
Bacteria= oral combined with soil
What I didn't include=
Drains,
Human bites (c and d)